Federal judge rules against TennCare

NASHVILLE, Tenn. The state’s expanded Medicaid program must hold hearings for people who have waited months to learn whether they qualify for coverage because of delays in processing applications, a federal judge has ruled.

The Tennessean (http://tnne.ws/1lxld2h) reports U.S. District Judge Todd Campbell made the ruling this week on the lawsuit brought by the Southern Poverty Law Center, the Tennessee Justice Center and the National Health Law Program.

The judge also granted class-action status to the lawsuit, meaning possibly thousands of Tennesseans could also become plaintiffs in the case.

The lawsuit accused the state of not providing in-person assistance and forcing applicants to apply for TennCare through the federal Health Insurance Marketplace website, which the lawsuit says was not designed for that purpose.

The lawsuit also accused the state of failing to let people know within 45 days if they’re eligible for Medicaid and failing to provide a hearing if there’s a delay in the eligibility decision.

The judge specifically addressed that issue by stopping TennCare from refusing to provide hearings within 45 days after one is requested about a delayed determination.

People requesting such a hearing must prove they have gone 45 days without learning the outcome of their application when eligibility is based on income or 90 days when it is based on disability. The injunction became effective immediately.

Campbell said in the order that “it is clear that irreparable harm has occurred and will continue to occur without the issuance of injunctive relief.”

“The plaintiff class members are economically impoverished and, without TennCare benefits, have forgone or are forgoing vital medical treatments, services and prescriptions,” he said. “These injuries cannot be made whole by a retroactive award of money after the litigation process is complete.”

Michael Kirk, the attorney for TennCare, blamed federal officials, saying they had failed to provide the state with certain information about the plaintiffs that would allow state officials to properly handle appeals.

But plaintiffs’ attorney Christopher Coleman argued the state created its own problems and should be held responsible.

Campbell ruled that TennCare could not delegate its responsibilities under the Medicaid program to some other entity, “whether that entity is a private party or the federal government.”

Advocates for the plaintiffs applauded the judge’s ruling, and said they’re willing to work with the state to help applicants get the health care they seek.

“We are jubilant that the vulnerable Tennesseans will now get the care upon which their lives and futures depend,” said Michele Johnson, executive director of The Tennessee Justice Center. “We look forward to working with state officials to develop a process that protects the health of Tennesseans and the infrastructure upon which we all rely.”